Credentialing Specialist - Tucson and Phoenix, AZ (Corporate-Bonita)

Join Intermountain Centers

Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona. We are looking for career-minded individuals interested in opportunities within the largest adult and child service continuum in Arizona.

We offer top-level compensation packages, exceptional health, dental, and disability benefits, career and compensation advancement programs, student loan forgiveness programs, 401k company match, bilingual pay differential, holiday, PTO and employer paid life insurance, clinical licensure supervision and reimbursement, and evidence-based treatment approaches, training, and supervision.

We are currently recruiting for a role responsible for initiating, coordinating, monitoring, and managing credentialing processes with contracted health plans. This role facilitates all aspects of practitioner, organizational, and facility credentialing, in accordance with state, federal, and health plan requirements. It ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. The role is also responsible for the accuracy and integrity of the credentialing software system and management of related applications.

Job Responsibilities Include:

• Ensuring licensed independent practitioners, medical providers, therapeutic foster families, and site locations meet credentialing requirements as set forth by each contracted health plan.
• Collaborating with program manager and HR to compile and submit credentialing documents and applications necessary to implement the credentialing process.
• Performing initial review of credentialing documents to ensure practitioner is in good standing with CAQH, AHCCCS and licensing board(s).
• Identifying issues/discrepancies that require additional review and follow-up.
• Completing requests and/or updates for Medicare, AHCCCS IDs, CAQH, NPI and other steps needed for the credentialing process.
• Performing re-credentialing activities upon request and within time frames specified by the health plan.
• Managing and maintaining credentialing files and/or profiles as needed to ensure provider information is accurate and up to date.
• Managing, tracking and monitoring provider credentialing/re-credentialing applications from submission to completion.
• Maintaining credentialing software with current provider and site information.
• Responding to inquiries from healthcare organizations, interfaces with internal and external customers, as needed.
• Creating and distributing credentialing status reports on a regular basis.
• Performing reconciliation and maintenance activities of health plan directories/rosters as required by health plan.
• Performing on-going credentialing audits; conducting internal file audits.
• Performing query, report and document generation; submitting and retrieving National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
• Managing the initial, reappointment and expirable process for all Behavioral Health Medical Professionals and Independently Licensed Professional staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
• Responsible for following all policies, procedures, and controls established by the organization, the HIPAA Privacy Officer, and/or the HIPAA Security Officer regarding access to, protection of, and the use of the PHI.

Qualifications:

• Education High School Diploma or GED required.
• Experience At least 3 (three) years of experience in a health care environment performing provider enrollment, credentialing and/or some contracting tasks, preferably with a behavioral health agency or health plan.
• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Questions about this position? Contact us at View email address on click.appcast.io.

Intermountain Centers is an equal opportunity employer. Intermountain Centers does not discriminate based on any protected class.